title: Prolactin response to electroconvulsive therapy: effects of electrode placement and stimulus dosage.
abstract: BACKGROUND
  It is unclear whether the serum prolactin (PRL) surge following electroconvulsive therapy (ECT) is a marker of optimal ECT administration. We investigated the relations among PRL surge, stimulus parameters, and outcome in major depressive disorder (MDD).
  
  
  METHODS
  Seventy-nine patients with MDD were randomized in a double-blind trial to right unilateral (RUL) or bilateral (BL), and to low-dose (just above seizure threshold) or high-dose (2.5 x threshold) ECT.
  
  
  RESULTS
  Change in PRL (delta PRL) varied among treatment groups, with significant effects of electrode placement (BL > RUL, p < .006), electrical dosage (high > low, p < .04), and gender (female > male, p < .005). There was no evidence that clinical improvement was associated with greater PRL surge.
  
  
  CONCLUSIONS
  Although delta PRL varied with parameters impacting on response rates, these data indicate the PRL surge cannot serve as a useful index of clinically effective treatment. This finding does not support the view that diencephalic seizure propagation is necessary for ECT to exert therapeutic effects.
authors.affiliation: Department of Biological Psychiatry, New York State Psychiatric Institute, NY 10032, USA.
authors.forename: S H
authors.initials: SH
authors.lastname: Lisanby
authors.forename: D P
authors.initials: DP
authors.lastname: Devanand
authors.forename: J
authors.initials: J
authors.lastname: Prudic
authors.forename: D
authors.initials: D
authors.lastname: Pierson
authors.forename: M S
authors.initials: MS
authors.lastname: Nobler
authors.forename: L
authors.initials: L
authors.lastname: Fitzsimons
authors.forename: H A
authors.initials: HA
authors.lastname: Sackeim
mesh_terms: D000328:Adult; D003071:Cognition; D003866:Depressive Disorder / Q000097:blood* / Q000628:therapy*; D004311:Double-Blind Method; D004565:Electroconvulsive Therapy; D004566:Electrodes; D005260:Female; D006801:Humans; D008297:Male; D011388:Prolactin / Q000097:blood*; D011569:Psychiatric Status Rating Scales; D016896:Treatment Outcome
chemical_list: D011388:Prolactin